We evaluated the efficacy and safety of two chemical oocyte activators, strontium chloride (SrCl₂) and calcium ionophore A23187 (A23187), after ICSI for patients with low fertilization (PLF) (less than 30%). Eighty-five PLF were randomly divided two groups: 35 patients in the SrCl₂ group (SG) and 50 patients in the A23187 group (AG). The control group (CG) was 530 patients who had undergone ICSI without artificial oocyte activation (AOA). The fertilization rate after AOA significantly increased from 24.7% to 54.5% in SG and from 20.9% to 62.4% in AG. Without AOA, there were no clinical pregnancies, but with AOA, 6 of 22 in SG and 9 of 37 in AG achieved pregnancies. Twenty-two babies (twenty singletons and one pair of twins) born after AOA had no abnormalities at birth [CG: 3.0% (16/530), SG: 0% (0/12), AG: 0% (0/10)]. Also, none of the infants' developmental characteristics showed any significant difference from the CG. Consequently, AOA using A23187 or SrCl₂ is beneficial for PLF following ICSI and does not adversely affect the growth or health of infants in their first 4 yr. Further studies of clinical tests for proper patient selection, efficacy and safety of AOA in larger samples are needed.